ICD-10 Diagnosis Codes - Billing News

Medicaid Connecticut announced a new Explanation of Benefit (EOB) code, 4039 – “The primary diagnosis code is not covered” that would utilized on claims with the implementation of ICD-10 in the Connecticut Medical Assistance Program (CMAP) when a primary diagnosis code that is not covered is billed. Instead, the Department of Social Services (DSS) has allowed for this edit to “post and pay” rather than deny. This means, the EOB code will be displayed on the claim; however, the claim will not deny for this reason at this time. Providers are encouraged to take this time to make sure that their billing processes are compliant with the ICD-10 diagnosis code requirements. Once this edit is set to deny, providers will need to follow coding guidelines and not submit a diagnosis code that has been classified as an unacceptable principal diagnosis code as the principal diagnosis on their claims.

INDUSTRY NEWS TAGS: Medicaid Connecticut

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